Factors Associated With Improved Physical Performance in Individuals With Parkinson's Disease Using the Fisior® Sequential Square Mat Walking Training Program: A Secondary Gender-Stratified Analysis of a Randomized Controlled Trial.

Abstract

Background: Variability in functional response to exercise interventions in Parkinson's disease (PD) remains poorly understood. Sex-related differences in motor performance and rehabilitation outcomes have been described but are rarely examined within intervention studies. This study presents a secondary sex-stratified analysis of a previously published randomized controlled trial (RCT) to explore factors associated with differential improvements in physical performance.

Objectives: To analyze sex-specific factors associated with improvements in physical performance following a 12-week SSM Fisior® walking training program in individuals with PD.

Design: Secondary analysis of a RCT with a sex-stratified approach.

Methods: Fifty-two community-dwelling older adults (57.7% men; mean age 71.4 ± 8.0 years) participated in the study. Physical performance was assessed using the Short Physical Performance Battery (SPPB), FallSkip system, and Timed Up and Go (TUG) test. Changes in SPPB scores were analyzed using sex-stratified Spearman correlations and multivariable linear regression models adjusted for age, body mass index, baseline Barthel Index, sensory aids, polypharmacy, falls history, and prosthesis use.

Results: Women showed greater improvements in SPPB total score compared with men (0.73 ± 0.09 vs. 0.50 ± 0.09). In women, SPPB changes were significantly correlated with TUG performance, and TUG improvement remained independently associated with SPPB gains (β = 9.07; 95% CI: 1.34-19.49). In men, SPPB improvements were correlated with FallSkip gait, sit-to-stand performance, FallSkip total score, FallSkip time, and TUG performance. In adjusted models, SPPB gains were independently associated with age, TUG improvement, balance, and sit-to-stand performance.

Conclusion: Functional improvements following the intervention differed by sex. In women, mobility performance was the primary determinant of SPPB improvement, whereas in men, gains were associated with multiple domains including balance, strength, gait, and age. These findings support sex-specific considerations in exercise-based interventions for older adults.